Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-30 (of 47 Records) |
Query Trace: Smith BD [original query] |
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Integrating the Consolidated Framework For Implementation Research (CFIR) into a culturally responsive evaluation (CRE) approach to conduct mixed-method evaluations of diabetes prevention and management programs reaching underresourced populations and communities
Jacobs SR , Glasgow L , Amico P , Farris KD , Rutledge G , Smith BD . Prev Sci 2023 Diabetes is a significant population health threat. Evidence-based interventions, such as the Centers for Disease Control and Prevention's National Diabetes Prevention Program and diabetes self-management education and support programs, can help prevent, delay, or manage the disease. However, participation is suboptimal, especially among populations who are at an increased risk of developing diabetes. Evaluations of programs reaching populations who are medically underserved or people with lower incomes can help elucidate how best to tailor evidence-based interventions, but it is also important for evaluations to account for cultural and contextual factors. Culturally responsive evaluation (CRE) is a framework for centering an evaluation in the culture of the programs being evaluated. We integrated CRE with implementation and outcome constructs from the Adapted Consolidated Framework for Implementation Research (CFIR) to ensure that the evaluation produced useful evidence for putting evidence-based diabetes interventions to use in real-world settings, reaching populations who are at an increased risk of developing diabetes. The paper provides an overview of how we integrated CRE and CFIR approaches to conduct mixed-methods evaluations of evidence-based diabetes interventions. |
Prevalence and medical expenditures of diabetes-related complications among adult Medicaid enrollees with diabetes in eight U.S. states
Ng BP , Laxy M , Shrestha SS , Soler RE , Cannon MJ , Smith BD , Zhang P . J Diabetes Complications 2020 35 (3) 107814 AIMS: To estimate the prevalence and medical expenditures of diabetes-related complications (DRCs) among adult Medicaid enrollees with diabetes. METHODS: We estimated the prevalence and medical expenditures for 12 diabetes-related complications by Medicaid eligibility category (disability-based vs. non-disability-based) in eight states. We used generalized linear models with log link and gamma distribution to estimate the total per-person annual medical expenditures for DRCs, controlling for demographics, and other comorbidities. RESULTS: Among non-disability-based enrollees (NDBEs), 40.1% (in California) to 47.5% (in Oklahoma) had one or more DRCs, compared to 53.6% (in Alabama) to 64.8% (in Florida) among disability-based enrollees (DBEs). The most prevalent complication was neuropathy (16.1%-27.1% for NDBEs; 20.2%-30.4% for DBEs). Lower extremity amputation (<1% for both eligibilities) was the least prevalent complication. The costliest per-person complication was dialysis (per-person excess annual expenditure of $22,481-$41,298 for NDBEs; $23,569-$51,470 for DBEs in 2012 USD). Combining prevalence and per-person excess expenditures, the three costliest complications were nephropathy, heart failure, and ischemic heart disease (IHD) for DBEs, compared to neuropathy, nephropathy, and IHD for NDBEs. CONCLUSIONS: Our study provides data that can be used for assessing the health care resources needed for managing DRCs and evaluating cost-effectiveness of interventions to prevent and management DRCs. |
Estimated number of eligible Part B beneficiaries for the medicare diabetes prevention program at the county level and by urban-rural classification
Ng BP , Cheng YJ , Rutledge S , Cannon MJ , Zhang P , Smith BD . PLoS One 2020 15 (11) e0241757 INTRODUCTION: Diabetes imposes large health and financial burdens on Medicare beneficiaries. Type 2 diabetes can be prevented or delayed through lifestyle modification programs. In 2018, Medicare began to offer the Medicare Diabetes Prevention Program (MDPP), a lifestyle intervention, to eligible beneficiaries nationwide. The number of MDPP-eligible beneficiaries is not known, but this information is essential in efforts to expand the program and increase enrollment. This study aimed to estimate the number and spatial variation of MDPP-eligible Part B beneficiaries at the county level and by urban-rural classification. METHODS: Data from 2011-2016 National Health and Nutrition Examination Surveys and a survey-weighted logistic regression model were used to estimate proportions of prediabetes in the United States by sex, age, and race/ethnicity based on the MDPP eligibility criteria. The results from the predictive model were applied to 2015 Medicare Part B beneficiaries to estimate the number of MDPP-eligible beneficiaries. The National Center for Health Statistics' Urban-Rural Classification Scheme for Counties from 2013 were used to define urban and rural categories. RESULTS: An estimated 5.2 million (95% CI = 3.5-7.0 million) Part B beneficiaries were eligible for the MDPP. By state, estimates ranged from 13,000 (95% CI = 8,500-18,000) in Alaska to 469,000 (95% CI = 296,000-641,000) in California. There were 2,149 counties with ≤1,000 eligible beneficiaries and 11 with >25,000. Consistent with demographic patterns, urban counties had more eligible beneficiaries than rural counties. CONCLUSIONS: These estimates could be used to plan locations for new MDPPs and reach eligible Part B beneficiaries for enrollment. |
An examination of gender differences in the National Diabetes Prevention Program's Lifestyle Change Program
Jackson MC , Dai S , Skeete RA , Owens-Gary M , Cannon MJ , Smith BD , Jabrah R , Masalovich SE , Soler RE . Diabetes Educ 2020 46 (6) 580-586 PURPOSE: The purpose of the study was to examine how gender was related to enrollment and number of sessions attended in the National Diabetes Prevention Program's Lifestyle Change Program (DPP LCP). METHODS: To better understand program uptake, a population of those who would be eligible for the LCP was compared to those who enrolled. Estimates of those eligible were computed using data from the National Health and Nutrition Examination Survey, whereas enrollment and sessions attended were computed using data from the Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program. RESULTS: Results revealed that although similar numbers of males and females were eligible for the program, only 39 321 males versus 121 007 females had enrolled in the National DPP LCP by the end of 2017 (odds ratio = 3.20; 95% CI, 3.17-3.24). The gender differences persisted even when stratifying by age or race/ethnicity. In contrast, no significant gender differences were found between the average number of sessions attended for males (14.0) and females (13.8). DISCUSSION: Results of the study can help inform efforts to market and tailor programs to appeal more directly to men and other groups that are underrepresented in the National DPP LCP. |
Opioid dispensing among adult Medicaid enrollees by diabetes status
Ng BP , Rabold E , Guy GP Jr , Park C , Zhang P , Smith BD . Curr Med Res Opin 2020 36 (10) 1 Objective: Diabetes disproportionately affects low income individuals, many of whom are covered by Medicaid. Comorbidities and complications of diabetes can lead to chronic pain; however, little is known about opioid use patterns among Medicaid enrollees with diabetes. This study examined opioid dispensing among Medicaid enrollees by diabetes status.Methods: Medicaid claims data from 2014 were used to examine opioid dispensing by diabetes status among 622,992 adult enrollees aged 19-64 years. A logistic model adjusting for demographics and comorbidities was used to examine the association between diabetes and opioid dispensing among enrollees. Analyses were completed in 2019.Results: Overall, 61.6% of enrollees with diabetes filled at least one opioid prescription compared to 31.8% of enrollees without diabetes. A higher proportion of enrollees with diabetes had long-term opioid prescriptions (>90 days' supply) (with diabetes: 51.0% vs. without: 32.1%, p < 0.001). Characteristics of individual prescriptions, including daily morphine milligram equivalents (45.9 vs. 49.4), formulation (percent short-acting: 91.5% vs. 90.7%), and type of opioids (i.e. percent hydrocodone: 46.7 vs. 45.3), were similar for those with and without diabetes. After adjustment, enrollees with diabetes were 1.43 times more likely to receive an opioid prescription compared to those without (OR 1.43, 95% CI =1.40-1.46).Conclusions: Medicaid enrollees with diabetes were prescribed opioids more frequently and were more likely to have longer opioid supply than enrollees without diabetes. For practitioners who care for patients with diabetes, aligning pain management approaches with evidence-based resources, like the CDC Guideline for Prescribing Opioids for Chronic Pain, can encourage safer opioid prescribing practices. |
Retention among participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012-2017
Cannon MJ , Masalovich S , Ng BP , Soler RE , Jabrah R , Ely EK , Smith BD . Diabetes Care 2020 43 (9) 2042-2049 OBJECTIVE: To assess retention in the National Diabetes Prevention Program (DPP) lifestyle change program, which seeks to prevent type 2 diabetes in adults at high risk. RESEARCH DESIGN AND METHODS: We analyzed retention among 41,203 individuals who enrolled in Centers for Disease Control and Prevention (CDC)-recognized in-person lifestyle change programs at organizations that submitted data to CDC's Diabetes Prevention Recognition Program during January 2012-February 2017. RESULTS: Weekly attrition rates were typically <1-2% but were between 3.5% and 5% at week 2 and at weeks 17 and 18, where session frequency typically transitions from weekly to monthly. The percent of participants retained through 18 weeks varied by age (45.9% for 18-29 year olds, 53.4% for 30-44 year olds, 60.2% for 45-54 year olds, 66.7% for 55-64 year olds, and 67.6% for >/=65 year olds), race/ethnicity (70.5% for non-Hispanic whites, 60.5% for non-Hispanic blacks, 52.6% for Hispanics, and 50.6% for other), mean weekly percentage of body weight lost (41.0% for </=0% lost, 66.2% for >0 to <0.25% lost, 72.9% for 0.25 to <0.5% lost, and 73.9% for >/=0.5% lost), and mean weekly physical activity minutes (12.8% for 0 min, 56.1% for >0 to <60 min, 74.8% for 60 to <150 min, and 82.8% for >/=150 min) but not by sex (63.0% for men and 63.1% for women). CONCLUSIONS: Our results demonstrate the need to identify strategies to improve retention, especially among individuals who are younger or are members of racial/ethnic minority populations and among those who report less physical activity or less early weight loss. Strategies that address retention after the first session and during the transition from weekly to monthly sessions offer the greatest opportunity for impact. |
CDC recommendations for hepatitis C screening among adults - United States, 2020
Schillie S , Wester C , Osborne M , Wesolowski L , Ryerson AB . MMWR Recomm Rep 2020 69 (2) 1-17 Hepatitis C virus (HCV) infection is a major source of morbidity and mortality in the United States. HCV is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood, most commonly through injection drug use. No vaccine against hepatitis C exists and no effective pre- or postexposure prophylaxis is available. More than half of persons who become infected with HCV will develop chronic infection. Direct-acting antiviral treatment can result in a virologic cure in most persons with 8-12 weeks of all-oral medication regimens. This report augments (i.e., updates and summarizes) previously published recommendations from CDC regarding testing for HCV infection in the United States (Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rec 2012;61[No. RR-4]). CDC is augmenting previous guidance with two new recommendations: 1) hepatitis C screening at least once in a lifetime for all adults aged >/=18 years, except in settings where the prevalence of HCV infection is <0.1% and 2) hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is <0.1%. The recommendation for HCV testing that remains unchanged is regardless of age or setting prevalence, all persons with risk factors should be tested for hepatitis C, with periodic testing while risk factors persist. Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks. |
The importance of addressing depression and diabetes distress in adults with type 2 diabetes
Owens-Gary MD , Zhang X , Jawanda S , Bullard KM , Allweiss P , Smith BD . J Gen Intern Med 2018 34 (2) 320-324 People with type 2 diabetes often experience two common mental health conditions: depression and diabetes distress. Both increase a patient's risk for mortality, poor disease management, diabetes-related complications, and poor quality of life. The American Diabetes Association and the U.S. Preventive Services Task Force recommend routine evaluations for these conditions in adults for optimal disease management and prevention of life-threatening complications. However, barriers exist within primary care and specialty settings that make screening for depression and diabetes distress challenging. Depression and diabetes distress influence diabetes self-care and diabetes control and barriers in clinical care practice that can hinder detection and management of psychosocial issues in diabetes care. This paper highlights opportunities to increase mental health screenings and provides strategies to help providers address depression and diabetes distress in patients with type 2 diabetes. |
Hepatitis C care cascade among persons born 1945-1965: 3 medical centers
Brady JE , Vellozzi C , Hariri S , Kruger DL , Nerenz DR , Brown KA , Federman AD , Krauskopf K , Kil N , Massoud OI , Wise JM , Seay TA , Smith BD , Yartel AK , Rein DB . Am J Manag Care 2018 24 (9) 421-427 OBJECTIVES: Effective screening, diagnosis, and treatment are needed to reduce chronic hepatitis C virus (HCV) infection-associated morbidity and mortality. In order to successfully increase HCV treatment, it is necessary to identify and understand gaps in linkage of antibody-positive patients with newly identified HCV to subsequent HCV RNA testing, clinical evaluation, and treatment. STUDY DESIGN: To estimate attainment of HCV care cascade steps among antibody-positive patients with newly identified HCV, we conducted chart reviews of patients with a new positive HCV antibody test at 3 academic medical centers participating in the Birth-Cohort Evaluation to Advance Screening and Testing of Hepatitis C (BEST-C) study. METHODS: We tracked receipt of RNA testing, clinical evaluation, treatment initiation, and treatment completion among individuals born between 1945 and 1965 who were newly diagnosed as HCV antibody-positive between December 2012 and October 2015 at 3 BEST-C centers, predominantly from the participating medical centers' primary care practices and emergency departments. RESULTS: Of the 130 HCV-seropositive individuals identified, 118 (91%) had an RNA or genotype test, 75 (58%) were RNA-positive, 73 (56%) were linked to care, 22 (17% overall; 29% among RNA-positive) started treatment, and 21 (16%; 28% among RNA-positive) completed treatment. CONCLUSIONS: This analysis showed that although linkage to care was largely successful in the target birth cohort, the largest gap in the HCV care cascade was seen in initiating treatment. Greater emphasis on linking patients to clinical evaluation and treatment is necessary in order to achieve the public health benefits promised by birth-cohort testing. |
Hepatitis C virus testing for case identification in persons born during 1945-1965: Results from three randomized controlled trials
Yartel AK , Rein DB , Ann Brown K , Krauskopf K , Massoud OI , Jordan C , Kil N , Federman AD , Nerenz DR , Brady JE , Kruger DL , Smith BD . Hepatology 2017 67 (2) 524-533 CDC and U.S. Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born during 1945-1965 (birth cohort). However, few studies estimate the effect of birth cohort (BC) testing implementation on HCV diagnoses in primary care settings. We aimed to determine the probability of identifying HCV infections in primary care using targeted BC testing compared with usual care at three academic medical centers. From December 2012 to March 2014, each center compared one of three distinct interventions to usual care using an independently-designed randomized controlled trial. Across centers, BC patients with no clinical documentation of previous HCV testing or diagnosis were randomly assigned to receive a one-time offering of HCV antibody (anti-HCV) testing via one of three independent implementation strategies (repeated-mailing outreach, EMR-integrated provider best practice alert [BPA], and direct patient-solicitation) or assigned to receive usual care. We estimated model-adjusted risk ratios (aRR) of anti-HCV positive (anti-HCV+) identification using BC testing versus usual care. In the repeated-mailing trial, 8,992 patients (intervention=2,993; control=5,999) were included in the analysis. The intervention was eight times as likely to identify anti-HCV+ patients compared with control (aRR 8.0, 95%CI 2.8-23.0; adjusted probabilities: intervention=0.27%; control=0.03%). In the BPA trial, data from 14,475 patients (BC=8,928; control=5,547) were analyzed. The intervention was 2.6 times as likely to identify anti-HCV+ patients versus control (aRR 2.6, 95%CI 1.1-6.4; adjusted probabilities: intervention=0.29%; control=0.11%). In the patient-solicitation trial, 8,873 patients (BC=4,307; control=4,566) were analyzed. The intervention was five times as likely to identify anti-HCV+ patients compared with control (aRR 5.3, 95%CI 2.3-12.3; adjusted probabilities: intervention=0.68%; control=0.11%). CONCLUSION: BC testing was effective in identifying previously undiagnosed HCV infections in primary care settings. This article is protected by copyright. All rights reserved. |
An electronic health record-based intervention to promote hepatitis C virus testing among adults born between 1945 and 1965: A cluster-randomized trial
Federman AD , Kil N , Kannry J , Andreopolous E , Toribio W , Lyons J , Singer M , Yartel A , Smith BD , Rein DB , Krauskopf K . Med Care 2017 55 (6) 590-597 BACKGROUND: The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. OBJECTIVE: To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. DESIGN: Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. SUBJECTS AND SETTING: Ten community and hospital-based primary care practices. Participants were attending physicians and medical residents during 25,620 study-eligible visits. INTERVENTION: Physicians in all practices received a brief introduction to the CDC testing recommendations. At visits for eligible patients at intervention sites, physicians received a BPA through the EHR to order HCV testing or medical assistants were prompted to post a testing order for the physician. Physicians in control sites did not receive the BPA. MAIN OUTCOMES: HCV testing; the incidence of HCV antibody positive tests was a secondary outcome. RESULTS: Testing rates were greater among Birth Cohort patients in intervention sites (20.2% vs. 1.8%, P<0.0001) and the odds of testing were greater in intervention sites after controlling for imbalances of patient and visit characteristics between comparison groups [odds ratio (OR), 9.0; 95% confidence interval, 7.6-10.7). The adjusted OR of identifying HCV antibody positive patients was also greater in intervention sites (OR, 2.1; 95% confidence interval, 1.3-11.2). CONCLUSIONS: An EHR-embedded BPA markedly increased HCV testing among Birth Cohort patients, but the majority of eligible patients did not receive testing indicating a need for more effective methods to promote uptake. |
Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C Study
Brady JE , Liffmann DK , Yartel A , Kil N , Federman AD , Kannry J , Jordan C , Massoud OI , Nerenz DR , Brown KA , Smith BD , Vellozzi C , Rein DB . Hepatology 2016 65 (1) 44-53 BACKGROUND: From December 2012-March 2014, three randomized trials, each implementing a unique intervention in primary care settings (mail recruitment [repeated-mailing], an electronic health record best practice alert [BPA], and patient-solicitation [patient-solicitation]), evaluated HCV antibody testing, diagnosis, and costs for each of the interventions compared to standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing. RATIONALE: To estimate the effects of interventions conducted as part of the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C study on hepatitis C virus (HCV) testing and costs among persons of the 1945-1965 birth-cohort (BC). MAIN RESULTS: Intervention resulted in substantially higher HCV testing rates compared to standard-of-care (26.9% vs. 1.4% for repeated-mailing, 30.9% vs. 3.6% for BPA, and 63.5% vs. 2.0% for patient-solicitation), and significantly higher aRR for testing after controlling for sex, birth year, race, insurance type, and median household income (19.2 [95% Confidence Interval (CI) 9.7-38.2] for repeated-mailing, 13.2 [95% CI 3.6-48.6] for BPA, and 32.9 [95% CI 19.3-56.1] for patient-solicitation). The BPA intervention had the lowest incremental cost per completed test ($24 with fixed startup costs, $3 without) and also the lowest incremental cost per new case identified after omitting fixed startup costs ($1,691). CONCLUSION: HCV testing interventions resulted in an increase in BC testing compared to standard-of-care but also increased costs. The effect size and incremental costs of BPA intervention (excluding startup costs) support more widespread adoption compared to the other interventions. |
Implementation of birth-cohort testing for hepatitis C virus: lessons learned from three primary care sites
Kruger DL , Rein DB , Kil N , Jordan C , Brown KA , Yartel A , Smith BD . Health Promot Pract 2016 18 (2) 283-289 Hepatitis C virus infection affects approximately 2.2 to 3.2 million Americans. In 2012, the Centers for Disease Control and Prevention recommended a one-time antibody test of all persons belonging to the 1945-1965 birth cohort. Efforts to implement this recommendation in clinical settings are in their infancy; this case study report therefore seeks to share the experiences of three sites that implemented interventions to increase birth-cohort testing through participation in the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C. At each site, project managers completed standardized questionnaires about their implementation experiences, and a qualitative analysis was conducted of the responses. The testing interventions used in-person recruitment, mail recruitment, and an electronic health record prompt. Sites reported that early efforts to obtain stakeholder buy-in were critical to effectively implement and sustain interventions and that the intervention required additional staffing resources beyond those being used for risk-based testing. In each case, administrative barriers were more extensive than anticipated. For the electronic health record-based intervention, technological support was critical in achieving study goals. Despite these barriers, interventions in all sites were successful in increasing rates of testing and case identification, although future studies will need to evaluate the relative costs and benefits of each intervention. |
Early identification and linkage to care for people with chronic HBV and HCV infection: The HepTLC Initiative
Ramirez G , Cabral R , Patterson M , Schoenbachler BT , Bedell D , Smith BD , Vellozzi C , Beckett GA . Public Health Rep 2016 131 5-11 OBJECTIVE: In 2012, CDC's Division of Viral Hepatitis launched a public health initiative to increase hepatitis B virus (HBV) and hepatitis C virus (HCV) infection testing for those at risk and to improve linkage to medical care for those infected. We describe testing outcomes of previously unidentified people at risk for HBV and HCV infection and the lessons learned while linking patients to care. METHODS: CDC's Hepatitis Testing and Linkage to Care (HepTLC) initiative provided 34 financial awards to U.S. organizations that serve people at risk for viral hepatitis, 25 of which focused on HCV and nine of which focused on HBV. Grantees offered testing and test result notification to people at risk for HBV and/or HCV infection, as well as counseling, referral, and verification or notification of linkage to care for people with positive test results. We entered demographic data, self-reported risk factors, country of origin (for HBV), and testing outcomes into a confidential database. RESULTS: The 34 grantees tested 87,860 people at more than 260 sites in 17 states. Of the 23,144 people tested for HBV, 1,317 (6%) were positive. Of the 64,716 people tested for HCV, 57,570 (89%) received an HCV antibody (anti-HCV) test, of whom 7,580 (13%) tested anti-HCV positive. Of the 4,765 people who received an HCV RNA test, 3,449 (72%) tested positive. Of the 4,766 people who tested positive for either HBV or HCV infection, 2,116 (44%) were linked to care. CONCLUSION: Interventions targeting people at risk for HBV and HCV infection reached a substantial number of people for whom testing is recommended and identified a large proportion of those who had previously unrecognized infection. Patient navigation was critical for follow-up and linkage to care. |
Hepatitis C virus testing and linkage to care in North Carolina and South Carolina jails, 2012-2014
Schoenbachler BT , Smith BD , Sena AC , Hilton A , Bachman S , Lunda M , Spaulding AC . Public Health Rep 2016 131 98-104 OBJECTIVE: We evaluated a hepatitis C virus (HCV) testing and linkage-to-care post-release program among detainees of small- to medium-sized jails in North Carolina and South Carolina as part of the Hepatitis Testing and Linkage to Care initiative. METHODS: An HCV testing and linkage-to-care program was implemented in selected jails in North Carolina and South Carolina from December 2012 to March 2014. Health-care workers not affiliated with the jails conducted HCV antibody (anti-HCV) and HCV ribonucleic acid (RNA) testing and linkage-to-care activities. The North Carolina jail provided universal opt-out testing for HCV; South Carolina jails initially targeted high-risk individuals before expanding to routine testing. RESULTS: Of 669 detainees tested for HCV in North Carolina, 88 (13.2%) tested anti-HCV positive, of whom 81 (92.0%) received an HCV RNA test, 66 (81.5%) of whom tested HCV RNA positive (i.e., currently infected). Of the 66 detainees with current HCV infection, 18 were referred to HCV medical care post-release and 10 attended their first appointment. Of 224 detainees tested for HCV in South Carolina, 18 (8.0%) tested anti-HCV positive, of whom 13 received an HCV RNA test. Nine of 13 detainees tested HCV RNA positive, seven detainees were referred to post-release medical care, and two detainees attended their first appointment. Overall, 106 of 893 (11.9%) detainees were anti-HCV positive. CONCLUSION: This study demonstrated that HCV testing, identification of infection, and linkage to care are feasible among jail populations. The rate of anti-HCV positivity was lower than that found in national studies of incarcerated populations, suggesting that HCV infection prevalence in jails may vary across U.S. states or regions. |
Results of hepatitis C birth-cohort testing and linkage to care in selected U.S. sites, 2012-2014
Patel RC , Vellozzi C , Smith BD . Public Health Rep 2016 131 12-19 OBJECTIVE: Following its recommendation for one-time hepatitis C virus (HCV) testing of people born between 1945 and 1965, CDC implemented the Hepatitis Testing and Linkage to Care (HepTLC) initiative to conduct birth-cohort hepatitis testing in U.S. health-care settings. We describe demographic characteristics, HCV infection prevalence, and HCV-related risk factors among people born between 1945 and 1965 who were tested as part of the program, which ran from 2012 to 2014. METHODS: As part of the HepTLC initiative, 14 grantees supporting 104 health-care sites in 21 U.S. municipalities tested participants born between 1945 and 1965 for HCV antibody (anti-HCV). Demographic characteristics and HCV risk factors were reported for people tested for anti-HCV and who were anti-HCV or HCV RNA positive. We evaluated outcomes along the HCV testing-to-care continuum using the following indicators: anti-HCV positive, HCV RNA test offered, HCV RNA positive, referred to care, and attended first medical appointment. RESULTS: Among 24,966 people tested for HCV infection, 2,900 (11.6%) were anti-HCV positive. Anti-HCV positivity was highest among those who self-identified as non-Hispanic black (n=1,701 of 12,202, 13.9%), men (n=2,073 of 12,130, 17.1%), and people born between 1951 and 1955 (n=795 of 5,768, 13.8%). Of the 2,900 people testing anti-HCV positive, 2,108 (72.7%) received an HCV RNA test, 1,497 (51.6%) were HCV RNA positive, 1,201 (41.4%) were referred to care, and 938 (32.3%) attended their first appointment. CONCLUSION: Testing for HCV infection among those born between 1945 and 1965 without soliciting HCV risk factors was successful. Providers implementing birth-cohort testing should develop and evaluate strategies to improve outcomes along the testing-to-care continuum. |
No Differences in Achieving Hepatitis C Virus Care Milestones Between Patients Identified by Birth Cohort vs Risk-based Screening
Norton B , Southern WN , Steinman M , Smith BD , Deluca J , Rosner Z , Litwin AH . Clin Gastroenterol Hepatol 2016 14 (9) 1356-60 National hepatitis C virus (HCV) screening guidelines recommended 1-time testing of persons born between 1945 and 1965. We performed a retrospective study to compare care milestones achieved by HCV-infected patients identified by birth cohort vs risk-based screens. We determined the proportions of patients newly identified with HCV infection who met care milestones (viral load, referral to and evaluation by a specialist, offer of treatment, initiation of treatment, and sustained viral response) and the time it took to reach them. We found no differences in HCV care milestones for patients identified via birth cohort testing vs risk-based screening. Overall, only 43% of HCV antibody-positive patients were referred to care, and less than 4% started treatment. The time to each care milestone was lengthy and varied greatly; treatment was initiated in a median of 308 days. Although birth cohort testing will likely increase identification of patients with HCV infection, it does not appear to increase the number of patients that meet management milestones. New methods are needed to increase access to care and establish efficient models of health care delivery. |
Hepatitis C virus testing perspectives among primary care physicians in four large primary care settings
Jewett A , Garg A , Meyer K , Wagner LD , Krauskopf K , Brown KA , Pan JJ , Massoud O , Smith BD , Rein DB . Health Promot Pract 2015 16 (2) 256-63 BACKGROUND: In 1998, the Centers for Disease Control and Prevention (CDC) published Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease, recommending HCV testing for populations most likely to be infected with HCV. However, the implementation of risk-based screening has not been widely adopted in health care settings, and 45% to 85% of infected U.S. adults remain unidentified. OBJECTIVES: To develop a better understanding of why CDC's 1998 recommendations have had limited success in identifying persons with HCV infection and provide information about how CDC's 2012 Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945-1965 may be implemented more effectively. DESIGN: Qualitative data were collected and analyzed from a multidisciplinary team as part of the Birth Cohort Evaluation to Advance Screening and Testing for Hepatitis C project. RESPONDENTS: Nineteen providers were asked open-ended questions to identify current perspectives, practices, facilitators, and barriers to HCV screening and testing. Providers were affiliated with Henry Ford Hospital, Mount Sinai Hospital, the University of Alabama, and the University of Texas Health Science Center. RESULTS: Respondents reported the complexity of the 1998 recommendations, and numerous indicated risk factors were major barriers to effective implementation. Other hindrances to hepatitis C testing included physician discomfort in asking questions about socially undesirable behaviors and physician uncertainty about patient insurance coverage. CONCLUSION: Implementation of the CDC's 2012 recommendations could be more successful than the 1998 recommendations due to their relative simplicity; however, effective strategies need to be used for dissemination and implementation for full success. |
A birth-cohort testing intervention identified hepatitis C virus infection among patients with few identified risks: a cross-sectional study
Southern WN , Norton B , Steinman M , DeLuca J , Drainoni ML , Smith BD , Litwin AH . BMC Infect Dis 2015 15 (1) 553 BACKGROUND: International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. METHODS: We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project. RESULTS: Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5 % vs. 49.5 %, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0 % vs. 46.7 %, p = 0.002), or the composite any risk-associated factor (55.9 % vs. 79.0 %, p = 0.002). CONCLUSIONS: Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy. |
HIV infection status as a predictor of hepatitis C virus RNA testing in primary care
Yartel AK , Morgan RL , Rein DB , Ann Brown K , Kil NB , Massoud OI , Fallon MB , Smith BD . Am J Prev Med 2015 49 (3) 423-7 INTRODUCTION: Receipt of hepatitis C virus (HCV) RNA testing following a positive HCV antibody (anti-HCV+) test result to establish current infection is a quality indicator for HCV-related care. This study examines HIV infection status as a predictor of HCV RNA test receipt after an anti-HCV+ result in the primary care setting. METHODS: Electronic medical records of anti-HCV+ patients from a multisite retrospective study of patients aged ≥18 years who utilized one or more primary care outpatient services during 2005-2010 were analyzed in 2014. A multivariable logistic regression model examined the independent relationships between patient characteristics and receipt of HCV RNA testing. RESULTS: Among 1,115 anti-HCV+ patients, 133 (11.9%) were also HIV-positive. Of these, 77.4% (n=103) underwent HCV RNA testing to determine current infection status. By contrast, 66.7% (n=654/980) of anti-HCV+ patients who were HIV-negative received HCV RNA testing. Following multivariable adjustment, the odds of receiving HCV RNA testing were higher among anti-HCV+ patients who were also HIV-positive (AOR=1.9, 95% CI=1.2, 3.0), compared with their HIV-negative counterparts. Elevated alanine aminotransferase level was also associated with receipt of HCV RNA testing (AOR=1.9, 95% CI=1.4, 2.4). Black race was associated with decreased odds of receiving HCV RNA testing (AOR=0.7, 95% CI=0.5, 1.0). CONCLUSIONS: HIV infection status is independently associated with the likelihood of receiving HCV RNA testing following an anti-HCV+ result. One quarter of anti-HCV+ patients who were also HIV-positive and one third of their HIV-negative counterparts, respectively, did not receive testing to establish active HCV infection, which is imperative for appropriate care and treatment. |
The cost-effectiveness, health benefits, and financial costs of new antiviral treatments for hepatitis C virus
Rein DB , Wittenborn JS , Smith BD , Liffmann DK , Ward JW . Clin Infect Dis 2015 61 (2) 157-68 BACKGROUND: New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications increasing demand for treatment and health care costs. The cost-effectiveness of new treatments is unknown. METHODS: We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the U.S. population aged 20 and older to estimate cases identified, treated, sustained viral response (SVR); deaths; medical costs; quality-adjusted life years (QALYs); and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective. RESULTS: Compared to treatment with pegylated interferon, ribavirin (PR), and a protease inhibitor (PI) for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555,226, reduced deaths by 80,682, at an incremental cost of $26.2 billion, and an ICER of $47,304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1,110,451 and reduced deaths by an additional 164,540 at an incremental cost of $80.1 billion and an ICER of $72,169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24,921 and $25,405 per QALY gained as compared to SS/SR. CONCLUSIONS: New treatments are cost-effectiveness per person treated but pent up demand for treatment may create challenges for financing. |
Hepatitis C virus (HCV) antibody positivity and predictors among previously undiagnosed adult primary care outpatients: cross-sectional analysis of a multi-site retrospective cohort study
Smith BD , Yartel AK , Krauskopf K , Massoud OI , Brown KA , Fallon MB , Rein DB . Clin Infect Dis 2015 60 (8) 1145-52 BACKGROUND: HCV testing guidance issued by CDC in 1998 recommends HCV antibody (anti-HCV) testing for persons with specified risk factors. The purpose of this study was to determine the prevalence and predictors of anti-HCV positivity among primary care outpatients and estimate the proportion of unidentified anti-HCV+ persons using risk-based testing. METHODS: We analyzed electronic medical record data from a four-site retrospective study. Patients were aged ≥18 years, utilized ≥1 outpatient primary care service(s) between 2005 and 2010, and had no documented evidence of prior HCV diagnosis. Among persons tested for anti-HCV, we fit a multilevel logistic regression model to identify patient-level independent predictors of anti-HCV positivity. We estimated the proportion of unidentified anti-HCV+ persons by using multiple imputation to assign anti-HCV results to untested patients. RESULTS: We observed 209,076 patients for a median of 5 months (interquartile range: 1-23). Among 17,464 (8.4%) patients who were tested for anti-HCV, 6.4% (n=1,115) were positive. We identified history of injection drug use (adjusted odds ratio, 95%CI: 6.3, 5.2-7.6), 1945-1965 birth cohort (4.4, 3.8-5.1), and elevated alanine aminotransferase levels (4.8, 4.2-5.6) as independently associated with anti-HCV positivity. We estimated that 81% (n=4,890/6,005) of anti-HCV+ patients were unidentified using risk-based testing. CONCLUSIONS: In these outpatient primary care settings, risk-based testing may have missed four of five newly enrolled patients who are anti-HCV+. Without knowing their status, unidentified anti-HCV+ persons cannot receive further clinical evaluation, antiviral treatment, and are unlikely to benefit from secondary prevention recommendations to limit disease progression and mortality. |
Comparison of hepatitis C virus testing strategies: birth cohort versus elevated alanine aminotransferase levels
Smith BD , Yartel AK . Am J Prev Med 2014 47 (3) 233-41 BACKGROUND: Hepatitis C virus (HCV) infection is unidentified in an estimated 40%-85% of infected adults. Surveillance and modeling data have found significant increases in HCV-associated morbidity and mortality. PURPOSE: To compare two HCV antibody (anti-HCV) testing strategies based on (1) elevated alanine aminotransferase levels (ALT) and (2) a birth cohort approach for people born during 1945-1965. METHODS: Data from 19,055 adults aged 20-70 years who completed the National Health and Nutrition Examination Survey in 1999-2008 were analyzed in 2013. Two independent models were evaluated, based on membership in the 1945-1965 birth cohort or elevated ALT, to compare the number of identified anti-HCV-positive (anti-HCV+) individuals; proportion of total identified cases; and the number of people that would be tested using either strategy. RESULTS: The prevalence of anti-HCV among adults aged 20-70 years was estimated at 2.0% (95% CI=1.8%, 2.3%), representing about 3.6 million people. The birth cohort strategy would result in testing about 85.4 million people and identifying nearly 2.8 million anti-HCV+ people with a sensitivity of 76.6%. The ALT strategy would test about 21.5 million adults and identify approximately 1.8 million anti-HCV+ people with a sensitivity of 50.0%. Implementing both strategies concurrently would identify 87.3% of anti-HCV+ adults. CONCLUSIONS: The birth cohort strategy, which is recommended by both the CDC and the U.S. Preventive Services Task Force, would identify 1 million more anti-HCV+ people than the elevated ALT approach. Concurrent implementation would identify an even larger number of individuals ever infected. |
Point-of-care tests for HIV, related coinfections, and blood-borne infections
Pant Pai N , Peeling RW , Smith BD , Dowdy D . AIDS Res Treat 2014 2014 625082 In the past 2 decades, rapid and point-of-care tests (POCTs) for HIV have facilitated a rapid increase in the uptake of HIV testing in sub-Saharan Africa, Asia, and the United States. POCTs for HIV are now commercially available to either detect early infection or ascertain degree of immunosuppression and monitor disease progression, thereby improving patient management. Some rapid HIV tests have evolved into POCTs, and some POCTs have even progressed into over-the-counter self- or home-based tests. In addition to the availability of unique rapid tests for hepatitis C, hepatitis B, and syphilis, multiplexed POCTs can now detect these infections using a single point-of-care device. Integration of POCT with other technologies has further expanded our ability to test and treat HIV coinfections and reduce morbidity and mortality due to HIV coinfections. For example, many POCTs for hepatitis C, hepatitis B, and syphilis are now as accurate compared to laboratory-based first-line tests, offering hope of expanded access to the millions that desire timely screening in outreach settings. In addition, novel tools like CD4 POC assays that have shown promising accuracy now offer hope of expedited triage and staging for antiretroviral treatment initiation. Timely testing and treatment will further reduce loss to followup of patients. | A quick evolution in rapid and POCT technology has catalyzed global research and policy. Implementation research with rapid and POC tests has strived to integrate some of these developments. The focus is shifting to novel testing strategies and programs that have been pilot-tested in different parts of the world, thereby offering hope of expanded access, improved patient engagement, and efficient service delivery in the times to come. |
Hepatitis C virus-related knowledge and willingness to receive treatment among patients on methadone maintenance
Zeremski M , Dimova RB , Zavala R , Kritz S , Lin M , Smith BD , Zibbell JE , Talal AH . J Addict Med 2014 8 (4) 249-57 OBJECTIVES: Although persons who inject drugs have high prevalence of hepatitis C virus (HCV) infection, few receive treatment mostly because of lack of knowledge about the infection and its treatment. We assessed the level of HCV-related knowledge and willingness to participate in HCV treatment among methadone-maintained patients. METHODS: A 30-item survey covering HCV-related knowledge and willingness to engage in HCV-related education and treatment was developed and completed by 320 methadone-maintained patients. RESULTS: Respondents' mean age was 53 +/- 8.7 years, 59.5% were male, 55.1% were African American, and 38.3% were Hispanic. The mean duration of methadone maintenance was 7 +/- 6.7 years. In the preceding 6 months, 6.9% of patients reported injection drug use, whereas 37.3% used noninjection drugs. Hepatitis C virus seropositivity was self-reported by 46.3% of patients. The majority of patients (78%) expressed willingness to participate in HCV-related education and to receive HCV treatment. Most patients (54.7%) correctly answered 5 or more of 7 questions assessing HCV knowledge. Hepatitis C virus-seropositive individuals and prior attendees at HCV-related educational activities demonstrated a higher level of HCV-related knowledge (P < 0.001 and P = 0.002, respectively). Younger patients (P = 0.014), those willing to attend an HCV-related educational activity (P < 0.001), and those with higher-HCV-related knowledge (P = 0.029) were more accepting of HCV treatment. Fear of medication-related side effects was the most common reason for treatment avoidance. CONCLUSIONS: The majority of patients reported willingness to receive HCV-related education and treatment. Treatment willingness was significantly associated with previous attendance at an HCV educational activity and a higher level of HCV-related knowledge. |
Successful integration of hepatitis C virus point-of-care tests into the Denver Metro Health Clinic
Jewett A , Al-Tayyib AA , Ginnett L , Smith BD . AIDS Res Treat 2013 2013 528904 BACKGROUND: The Centers for Disease Control and Prevention (CDC) recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV), including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC) testing into standard operations at an urban STD clinic. METHODS: The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC). All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative). Focus groups were conducted with triage staff, providers, and linkage-to-care counselors. RESULTS: Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care. CONCLUSION: DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection. |
Previous exposure to HCV among persons born during 1945-1965: prevalence and predictors, United States, 1999-2008
Smith BD , Beckett GA , Yartel A , Holtzman D , Patel N , Ward JW . Am J Public Health 2014 104 (3) 474-81 OBJECTIVES: We examined HCV exposure prevalence and predictors among persons in the United States born during 1945-1965. METHODS: With data from the 1999-2008 National Health and Nutrition Examination Survey, we calculated the proportion of persons born during 1945-1965 who tested positive for HCV antibody (anti-HCV) and analyzed the prevalence by sociodemographic and behavioral risk factors. RESULTS: Anti-HCV prevalence in the 1945-1965 birth cohort was 3.2% (95% confidence interval [CI] = 2.8%, 3.8%), substantially higher than among other adults (0.9%). Within the cohort, anti-HCV prevalence was higher among non-Hispanic Blacks (6.4%; 95% CI = 5.3%, 7.7%), persons with injection drug use histories (56.8%; 95% CI = 48.4%, 64.8%), and persons with elevated alanine aminotransferase levels (12.7%; 95% CI = 10.7%, 15.1%). Injection drug use (adjusted odds ratio = 98.4; 95% CI = 58.8, 164.5) was the strongest anti-HCV prevalence predictor. Among anti-HCV-positive persons, 57.8% reported having 2 or more alcoholic drinks daily. CONCLUSIONS: With the high prevalence of HCV among persons born during 1945-1965, the increasing morbidity and mortality associated with HCV, and reductions in liver cancer and HCV-related mortality when HCV is eradicated, it is critically important to identify persons with HCV and link them to appropriate care. |
Physician nonadherence with a hepatitis C screening program
Southern WN , Drainoni ML , Smith BD , Koppelman E , McKee MD , Christiansen CL , Gifford AL , Weinbaum CM , Litwin AH . Qual Manag Health Care 2014 23 (1) 1-9 BACKGROUND: Testing for patients at risk for hepatitis C virus (HCV) infection is recommended, but it is unclear whether providers adhere to testing guidelines. We aimed to measure adherence to an HCV screening protocol during a multifaceted continuous intervention. SUBJECTS AND METHODS: Prospective cohort design to examine the associations between patient-level, physician-level, and visit-level characteristics and adherence to an HCV screening protocol. Study participants included all patients with a visit to 1 of the 3 study clinics and the physicians who cared for them. Adherence to the HCV screening protocol and patient-level, physician-level, and visit-level predictors of adherence were measured. RESULTS: A total of 8981 patients and 154 physicians were examined. Overall protocol adherence rate was 36.1%. In multivariate analysis, patient male sex (odds ratio [OR] = 1.18), new patient (OR = 1.23), morning visit (OR = 1.32), and patients' preferred language being non-English (OR = 0.87) were significantly associated with screening adherence. There was a wide variation in overall adherence among physicians (range, 0%-92.4%). Screening adherence continuously declined from 59.1% in week 1 of the study to 13.7% in week 15 (final week). When implementing complex clinical practice guidelines, planners should address physician attitudinal barriers as well as gaps in knowledge to maximize adherence. |
"To share or not to share?" serosorting by hepatitis C status in the sharing of drug injection equipment among NHBS-IDU2 participants
Smith BD , Jewett A , Burt RD , Zibbell JE , Yartel AK , Dinenno E . J Infect Dis 2013 208 (12) 1934-42 BACKGROUND: Persons who inject drugs (PWID) are at high risk for acquiring hepatitis C virus (HCV) infection. CDC estimates there are 17,000 new infections per year, mainly among PWID. This study examines injection equipment serosorting - considering HCV serostatus when deciding whether and with whom to share injection equipment.OBJECTIVE: To examine whether injection equipment serosorting is occurring among PWID in selected cities. METHODS: Using data from the National HIV Behavioral Surveillance System-Injection Drug Users (NHBS-IDU2, 2009), we developed multivariate logistic regression models to examine the extent to which participants' self-reported HCV status is associated with their injection equipment serosorting behavior and knowledge of last injecting partner's HCV status.RESULTS:. Participants who knew their HCV status were more likely to know the HCV status of their last injecting partner, compared to those who did not know their status (HCV+: aOR 4.1, 95%CI 3.4-4.9; HCV-: aOR 2.5, 95%CI 2.0-3.0). Participants who reported being HCV+, relative to those of unknown HCV status, were five times more likely to share injection equipment with a partner of HCV-positive status (aOR 4.8, 95%CI 3.9-6.0). CONCLUSION: Our analysis suggests PWID are more likely to share injection equipment with persons of concordant HCV status. |
Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: a meta-analysis of observational studies
Morgan RL , Baack B , Smith BD , Yartel A , Pitasi M , Falck-Ytter Y . Ann Intern Med 2013 158 329-37 BACKGROUND: Hepatitis C virus (HCV) is a leading cause of hepatocellular carcinoma (HCC). In the United States, this form of cancer occurs in approximately 15,000 persons annually. A systematic review of the evidence is needed to assess the benefits of treatment of HCV-infected persons on development of HCC. PURPOSE: To systematically review observational studies to determine the association between response to HCV therapy and development of HCC among persons at any stage of fibrosis and those with advanced liver disease. DATA SOURCES: MEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science, and the Database of Abstracts of Reviews and Effectiveness from inception through February 2012. STUDY SELECTION: English-language observational studies that compared therapy-derived sustained virologic response (SVR) with no response to therapy among HCV-infected persons, targeted an adult population, and had an average follow-up of at least 2 years. DATA EXTRACTION: Two investigators independently extracted data into uniform relative risk measures. The Grading of Recommendations Assessment, Development and Evaluation framework was used to determine the quality of the evidence. DATA SYNTHESIS: Thirty studies fulfilled the inclusion criteria, and 18 provided adjusted effect estimates that were used to calculate pooled relative risks. Among HCV-infected persons, SVR was associated with reduced risk for HCC (relative risk for all persons, 0.24 [95% CI, 0.18 to 0.31], moderate-quality evidence; advanced liver disease hazard ratio, 0.23 [CI, 0.16 to 0.35], moderate-quality evidence). LIMITATION: In the meta-analyses, some variables could not be controlled for because of the observational design of the included studies. CONCLUSION: Sustained virologic response after treatment among HCV-infected persons at any stage of fibrosis is associated with reduced HCC. The evidence was determined to be of moderate quality. |
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